Why Shouldn't Nurses Manage Epidural Infusions?

Carolyn Buppert, MSN, JD

Disclosures

October 23, 2017

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Question

Nurses and Epidural Infusions

A labor and delivery nurse asked a question about the nurse's role during epidural anesthesia or analgesia. This question, said the nurse, was not clarified by her state's nurse practice act. "Should nurses be able to increase or decrease the infusion rate, or administer a bolus, under the orders of the anesthesia provider. Will we be judged by our professional organization's position statement on this matter?"

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

Answer From Carolyn Buppert

Your concern is reasonable. If something goes wrong, a patient suffers an injury, and the patient sues the hospital, the first thing the patient's attorney will do is research the standard of care for nurses for adjusting epidural analgesia.

The Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) position statement "Role of the Registered Nurse in the Care of the Pregnant Woman Receiving Analgesia and Anesthesia by Catheter Techniques" (readily available online) addresses the nurse's role in managing epidural, intrathecal, spinal and patient-controlled epidural analgesia catheters in the labor and delivery setting. If you do something other than what the national organization states, the nurses involved and the hospital very likely will lose the lawsuit and be held liable. No judge or jury, if asked to consider your facts, would disregard the AWHONN's standards on the rationale that it was inconvenient for an anesthesiologist to come and evaluate the patient.

If the hospital acquiesces to the pushback from the anesthesiologists, the hospital is putting itself, the patients, and the nurses at risk. Furthermore, if the state licensing board found out the nurses were doing something contrary to the generally accepted standard of care, the board could discipline the nurses.

There are reasons why AWHONN wrote the position statement the way they did. The patient's breakthrough pain may not be due to inadequate dose, but to a malfunctioning or dislodged catheter, and it is up to an anesthesiologist or certified registered nurse anesthetist to figure out why the previously ordered analgesia isn't effective.

Please, stick with the AWHONN position statement.

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